Mendocino Co. moving forward with mental health service contracts

The county is set to take the next step Tuesday in a process that started in 2011 to contract out its mental health services.

The Mendocino County Board of Supervisors will on Tuesday consider hiring two contractors to directly provide mental health services for children and adults. The county would oversee the contracts. The county issued a request for proposals in October, and bidding closed Jan. 15.

"For decades, the mental health services have been provided by Mendocino County Behavioral Health," according to a staff report prepared for the board. "In short, it was time to consider a different way of doing business. The goal is to provide better services to our clients tomorrow than we do today through an enhanced delivery system."

The board will consider signing a contract to pay Redwood Management Company $8.8 million for children's mental health services and a $6.7 million contract with Ortner Management Group for adult mental health services.

The contracts include payment of additional amounts of $79,754 to OMG and $68,000 to RMC for "transition of services" for the month of June. If they are approved, the contracts would be effective in about a month's time, and would cover the 2013-14 fiscal year "with five additional renewals through 2019," according to the staff report.

Crisis response

For adults and clients younger than 21, emergency access would be available at "24/7 Access Centers ... inland and on the coast," according to the contracts. At the highest level of crisis care, "psychiatric emergency services," a decision would be made by phone about whether to send the client to an access center or to the nearest emergency room.

For clients of all ages needing the highest level of crisis care, "if there is no medical problem and the client can be (handled) without restraint," the client would go to an access center for assessment and triage rather than to an emergency room.

Both contracts also define crisis stabilization as "an alternative to higher cost emergency room services and inpatient hospitalizations." The option could include using medications, referral, counseling or "a short respite' from situational stressors or focus on basic needs for food, a shower and sleep." Adults can self-refer for crisis stabilization.

Adult mental health services

"Persons with a psychiatric or addiction disorder may not show visible signs of injury or illness; they often suffer extreme waiting times when competing for the attention of emergency room staff treating other critically ill patients or waiting for a bed," according to the OMG contract. An access center would offer quicker service, according to the contract.

OMG will provide direct mental health services to clients who are 21 and older. Inpatient hospitalizations will occur at North Valley Behavioral Health, Saint Helena Hospital, Woodland Memorial Hospital, Aurora Behavioral Healthcare and Marin General Hospital, where stays could last three to seven days.

The Sequoia Psychiatric Treatment Center, a locked facility in Yuba City, would provide rehabilitation services as "an alternative to some inpatient admissions ... a court-ordered placement site for persons incompetent to stand trial, a short-term placement for difficult to place clients and a moderate-term placement for clients with persistent behavioral problems," according to the contract.

Twenty-four-hour, intensive residential care would be available to clients "who are low functioning, difficult to place or have mild to moderate behavioral problems," and would aim to "prepare clients for personal responsibility and a return to community-based living," the contract states. Stays could last three to 12 months.

The next step down is placement at community living centers in Ukiah and Fort Bragg, where clients would be prepared to reintegrate into society. Stays are expected to last between one and six months.

Children's mental health services

Under its proposed contract with the county, RMC would "operate a no wrong door' access approach to all services," according to the contract. The vision is that a person needing services could show up at "any contracted Mendocino County mental health service program" and get help. According to the contract, "The client will be engaged and assisted immediately to meet his/her need."

RMC would provide mental health services -- including "a comprehensive array of services that address emotional, social and educational needs" -- to children younger than 21 through a "Multi-Agency Children's Coalition," according to the contract. The coalition would be advised by a quality council and leadership council, which would oversee improvement efforts and review outcomes.

In addition, an advisory council made of representatives from the county Health and Human Services Agency, stakeholders, court system, law enforcement, the Board of Supervisors, community providers, the Mendocino Mental Health Coalition, the National Alliance on Mental Illness and county Juvenile Justice/Probation, along with clients and family members, would meet quarterly and recommend policy change, program design and resource allocations.